Estimating cardiovascular health gains from eradicating indoor cold in Australia.

BACKGROUND: Exposure to cold indoor temperature (< 18 degrees Celsius) increases cardiovascular disease (CVD) risk and has been identified by the WHO as a source of unhealthy housing. While warming homes has the potential to reduce CVD risk, the reduction in disease burden is not known. We simulated the population health gains from reduced CVD burden if the temperature in all Australian cold homes was permanently raised from their assumed average temperature of 16 degrees Celsius to 20 degrees Celsius. METHODS: The health effect of eradicating cold housing through reductions in CVD was simulated using proportional multistate lifetable model. The model sourced CVD burden and epidemiological data from Australian and Global Burden of Disease studies. The prevalence of cold housing in Australia was estimated from the Australian Housing Conditions Survey. The effect of cold indoor temperature on blood pressure (and in turn stroke and coronary heart disease) was estimated from published research. RESULTS: Eradication of exposure to indoor cold could achieve a gain of undiscounted one and a half weeks of additional health life per person alive in 2016 (base-year) in cold housing through CVD alone. This equates to 0.447 (uncertainty interval: 0.064, 1.34; 3% discount rate) HALYs per 1,000 persons over remainder of their lives through CVD reduction. Eight percent of the total health gains are achievable between 2016 and 2035. Although seemingly modest, the gains outperform currently recommended CVD interventions including persistent dietary advice for adults 5-9% 5 yr CVD risk (0.017 per 1000 people, UI: 0.01, 0.027) and persistent lifestyle program for adults 5-9% 5 yr CVD risk (0.024, UI: 0.01, 0.027). CONCLUSION: Cardiovascular health gains alone achievable through eradication of cold housing are comparable with real-life lifestyle and dietary interventions. The potential health gains are even greater given cold housing eradication will also improve respiratory and mental health in addition to cardiovascular disease.

Mental health impacts of environmental exposures: A scoping review of evaluative instruments.

To date, much of the health focus of environmental policy has been on preventing physical health impacts of environmental exposures. Recent research has however highlighted increasingly concurrent mental health effects and its consideration is an emerging requirement for many governments and their agencies, yet there are limited universal mental health assessment tools for environmental exposures. This paper details the findings of a scoping review that evaluated assessment tools used to measure psychological impacts from environmental exposures and pollution, as reported in recent peer-reviewed literature (2000-2022). Across the 126 papers identified in our review, a wide range of tools to assess mental health impact were identified. We document a clear recent upswing of research interest in the mental and psychological impacts of environmental exposures, and an overarching concern for air pollution from industry, traffic, and fires. A majority of studies utilised standardised assessment instruments, but there was little consistency in the way that these were combined or deployed. The dominant mental health outcomes of interest in these studies were depression, anxiety, and mental and psychiatric health. The findings of the review identify a need and opportunity to develop a best-practice approach to consistently assess the mental health impacts arising from environmental exposures. Future work is needed to define the most appropriate choice and application of assessment tools to evaluate adverse mental health impacts from environmental exposures. This will support a more universal, coordinated and cross-jurisdiction approach for the assessment, quantification and targeted response to addressing mental health impacts arising from environmental exposures.

Cold housing environments: defining the problem for an appropriate policy response.

Researchers across disciplines are increasing attention to cold housing environments. Public health, environmental and social sciences, architecture, and engineering each define and measure cold housing environments differently. Lack of standardisation hinders our ability to combine evidence, determine prevalence, understand who is most at risk--and to formulate policy responses. We conducted a systematic, cross-disciplinary review of literature to document the measures used. We examined benefits and limitations of each approach and propose a conceptualisation of cold housing: where temperature is too low to support optimal health and wellbeing of inhabitants, measured using one or a combination of economic, 'objective', or subjective approaches. More accurate data on home temperatures for all population groups, combined with an understanding of factors leading to cold homes, will enable appropriate policy response to reduce adverse health effects and costs. Policies targeting better building standards and energy subsidies both improve temperature conditions in housing environments.

The effect of energy poverty on mental health, cardiovascular disease and respiratory health: a longitudinal analysis.

Background: Houses in mild-climate countries, such as Australia, are often ill-equipped to provide occupants protection during cold weather due to their design. As a result, we rely on energy to warm homes, however, energy is becoming increasingly expensive, and evidence is emerging of a sizable burden to population health of being unable to afford to warm homes causing exposure to cold indoor temperatures. Methods: We use a large longitudinal sample of adult Australians (N = 32,729, Obs = 288,073) collected annually between 2000 and 2019 to estimate the relationship between exposure to energy poverty and mental health (SF-36 mental health score), and a smaller sample from waves collected in 2008-9, 2012-13, and 2016-17 (N = 22,378, Obs = 48,371) to estimate the relationship between energy poverty and onset of asthma, chronic bronchitis or emphysema, hypertension, coronary heart disease, and depression/anxiety. Fixed effects and correlated random-effects regression was used in models. As exposure and outcomes were self-reported, we tested alternative specifications of each to examine bias from measurement error. Findings: When people can no longer afford to warm their homes, their mental health declines significantly (by 4.6-points on the SF-36 mental health scale, 95% CI -4.93 to -4.24), their odds of reporting depression/anxiety or hypertension increases by 49% (OR 1.49, 95% CI 1.09 to 2.02) and 71% (OR 1.71, 95% CI 1.13 to 2.58) respectively. The findings for the decline in mental health were supported in additional analyses that tested alternative specifications of the exposure measure, including co-resident verification of respondent reporting of being able to afford to warm the home. Support for an effect of energy poverty on hypertension was less clearly supported in these same sensitivity models. There was little evidence of an effect of energy poverty on asthma or chronic bronchitis onset in this adult population noting, however, that we could not examine exacerbation of symptoms. Interpretation: Reducing exposure to energy poverty should be considered as an intervention with clear benefits for mental health and potential benefits for cardiovascular health. Funding: National Health and Medical Research Council, Australia.

An Australian housing conditions data infrastructure.

For the past two decades, researchers and policy makers have known very little about conditions within Australia's housing stock due to a lack of systematic and reliable data. In 2022, a collaboration of Australian universities and researchers commissioned a large survey of 22,550 private rental, social rental and homeowner households to build a data infrastructure on the household and demographic characteristics, housing quality and conditions in the Australian housing stock. This is the third and largest instalment in a national series of housing conditions data infrastructures.

An Australian rental housing conditions research infrastructure.

Each year the proportion of Australians who rent their home increases and, for the first time in generations, there are now as many renters as outright homeowners. Researchers and policy makers, however, know very little about housing conditions within Australia's rental housing sector due to a lack of systematic, reliable data. In 2020, a collaboration of Australian universities commissioned a survey of tenant households to build a data infrastructure on the household and demographic characteristics, housing quality and conditions in the Australian rental sector. This data infrastructure was designed to be national (representative across all Australian States and Territories), and balanced across key population characteristics. The resultant Australian Rental Housing Conditions Dataset (ARHCD) is a publicly available data infrastructure for researchers and policy makers, providing a basis for national and international research.

Housing and health: an updated glossary.

Recent crises have underscored the importance that housing has in sustaining good health and, equally, its potential to harm health. Considering this and building on Howden-Chapman's early glossary of housing and health and the WHO Housing and Health Guidelines, this paper introduces a range of housing and health-related terms, reflecting almost 20 years of development in the field. It defines key concepts currently used in research, policy and practice to describe housing in relation to health and health inequalities. Definitions are organised by three overarching aspects of housing: affordability (including housing affordability stress (HAS) and fuel poverty), suitability (including condition, accessibility and sustainable housing) and security (including precarious housing and homelessness). Each of these inter-related aspects of housing can be either protective of, or detrimental to, health. This glossary broadens our understanding of the relationship between housing and health to further promote interdisciplinarity and strengthen the nexus between these fields.

A Multidisciplinary Exploratory Approach for Investigating the Experience of Older Adults Attending Hospital Services.

BACKGROUND: The public areas of the hospital built environment have hardly been investigated for their age-friendliness. OBJECTIVE: This exploratory, multidisciplinary pilot study investigates the relationship between the physical environment and design of hospital spaces and older people's outpatient experience. METHODS: Sixteen participants were recruited from a geriatric Outpatient Clinic at a metropolitan public hospital in Australia. Participants were engaged in a concurrent mixed-method approach, comprising a comprehensive geriatric survey, walking observation, semi-structured interview and an independent architectural audit. RESULTS: Several elements arising from the hospital environment were identified as facilitators and barriers for its utilization and intrinsically related to participants' physical capacity. DISCUSSION: Age-friendly hospital design needs to consider strategies to remove barriers for older adults of different capacities, thus promoting healthy aging.

The Shifting Risk of Homelessness among Persons with a Disability: Insights from a National Policy Intervention.

Persons with a disability are at a far higher risk of homelessness than those without. The economic, social and health challenges faced by disabled people are addressed, in Australia, by the recently implemented National Disability Insurance Scheme (NDIS). Using nationally representative, longitudinal household panel data, we construct the Index of Relative Homelessness Risk (IRHR) to track how the risk of homelessness for disabled persons has changed since the introduction of the NDIS. We find that, overall, fewer persons with a disability face moderate risk of homelessness but that many more face high risk. We conclude that the NDIS has not effectively protected disabled people from the risk of homelessness. We reflect on the implications of these findings for policy interventions.

Publisher Correction: The Scales Project, a cross-national dataset on the interpretation of thermal perception scales.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Housing Disadvantage and Poor Mental Health: A Systematic Review.

CONTEXT: This study reviews collective evidence on the longitudinal impact of housing disadvantage (based on tenure, precarity, and physical characteristics) on mental health. It is focused on temporally ordered studies where exposures preceded outcomes, a key criterion to establishing causal evidence. EVIDENCE ACQUISITION: A systematic review of evidence on housing disadvantage and mental health was performed. The literature search used six electronic databases including MEDLINE (PubMed and Ovid platform), Embase, PsycINFO, Web of Science, SciELO, and Sociological Abstracts. Population-based longitudinal studies where exposure to housing disadvantage (excluding exposure to homelessness) preceded mental health were included. Methodologic quality of selected studies was examined using the Newcastle-Ottawa Quality Assessment Scale. Because of definitional and methodologic heterogeneity among studies, narrative synthesis rather than meta-analysis was used to summarize research findings. EVIDENCE SYNTHESIS: Of the 1,804 unique titles identified in the literature search, 12 met the selection criteria for inclusion in the systematic review. Housing disadvantage was measured by overcrowding, mortgage delinquency, housing mobility, housing tenure, subjective perceptions of inadequate housing, eviction, and physical housing conditions. Mental health was measured as depression, psychological impairment, anxiety, allostatic load, mental strain, and psychological health. Study sample sizes ranged from 205 to 16,234 people, and the follow-up period ranged from within 1 year to 34 years. Each study indicated a positive association between housing disadvantage and mental health for at least one housing disadvantage measure and mental health outcome. CONCLUSIONS: This systematic review confirms that prior exposure to housing disadvantage may impact mental health later in life.

How Does Household Residential Instability Influence Child Health Outcomes? A Quantile Analysis.

At the core of housing and welfare research is a premise that stable residential environments are important to children's health and development. The relationship between housing stability and health outcomes for children is, however, complex; stable housing situations are sometimes associated with poorer health outcomes, and some children may be more or less resilient to residential instability. The Longitudinal Study of Australian Children (LSAC) dataset enables us to longitudinally follow the housing and health of more than 10,000 children and their families. We employ a quantile analysis technique, a currently underutilized tool for testing associations across the distribution of an outcome, to test whether exposure to housing instability has a differential impact on children's health dependent on their initial health status. Our findings suggest that the health outcomes of residential instability are highly dependent on children's initial health status.

The Relative Risk of Homelessness among Persons with a Disability: New Methods and Policy Insights.

This paper reports on the first phase of an ambitious program of research that seeks to both understand the risk of homelessness amongst persons with a disability in Australia and shed light on the impact of a significant policy reform-the introduction of the National Disability Insurance Scheme (NDIS)-in changing the level of homelessness risk. This first paper, reports on the level of homelessness risk for persons with a disability prior to the introduction of the NDIS, with a subsequent paper providing updated data and analysis for the period post the implementation of the NDIS. In one sense, this paper provides the 'base' condition prior to the introduction of the NDIS but also serves a far broader role in advancing our understanding of how disability and chronic ill-health affects the risk of homelessness. Our research finds that in the period prior to the introduction of the NDIS, a large proportion of people with disabilities were at risk of homelessness, but those whose disabilities affected their schooling or employment were at the greatest risk.

The Scales Project, a cross-national dataset on the interpretation of thermal perception scales.

Thermal discomfort is one of the main triggers for occupants' interactions with components of the built environment such as adjustments of thermostats and/or opening windows and strongly related to the energy use in buildings. Understanding causes for thermal (dis-)comfort is crucial for design and operation of any type of building. The assessment of human thermal perception through rating scales, for example in post-occupancy studies, has been applied for several decades; however, long-existing assumptions related to these rating scales had been questioned by several researchers. The aim of this study was to gain deeper knowledge on contextual influences on the interpretation of thermal perception scales and their verbal anchors by survey participants. A questionnaire was designed and consequently applied in 21 language versions. These surveys were conducted in 57 cities in 30 countries resulting in a dataset containing responses from 8225 participants. The database offers potential for further analysis in the areas of building design and operation, psycho-physical relationships between human perception and the built environment, and linguistic analyses.